POPULATION KNOWLEDGE, RISK PERCEPTION, GOVERNANCE AND PUBLIC HEALTH DETERMINANTS OF COVID-19 IN GEORGIA: A NATIONAL CROSS-SECTIONAL STUDY.

INTRODUCTION: The COVID-19 pandemic had a significant impact on public health systems both globally and in Georgia. It highlighted the importance of health system preparedness, risk communication, governance mechanisms, population behavior, and access to healthcare services. Despite the growing body of international evidence, a comprehensive assessment of the determinants of COVID-19 and the associated public health challenges in Georgia remains limited. AIM: The aim of this study was to assess the determinants of COVID-19 among the population of Georgia and to identify the social, behavioral, and governance-related factors influencing the effectiveness of pandemic management. OBJECTIVES: • To assess the population's knowledge, attitudes, and practices (KAP) regarding COVID-19 in Georgia. • To evaluate the social, demographic, and behavioral determinants associated with the COVID-19 pandemic. • To assess public perceptions of government regulations, risk communication, and public health interventions. • To identify the factors influencing the effectiveness of COVID-19 pandemic management. METHODS: A quantitative, analytical, population-based cross-sectional study was conducted to assess knowledge, attitudes, and practices (KAP) related to the COVID-19 pandemic, as well as the social, behavioral, and governance determinants of COVID-19 among the population of Georgia. The target population comprised adults aged 18 years and older who were permanent residents of Georgia. The minimum required sample size was calculated using OpenEpi (Version 3.01) with a 95% confidence level, a 5% margin of error, and an assumed population proportion of 50%, resulting in a minimum sample of 384 participants. A total of 386 respondents were included in the study. A multistage stratified sampling design was employed. In the first stage, Georgia was stratified into 11 geographical strata (Tbilisi and 10 administrative regions). The sample was allocated proportionally to population size (Probability Proportional to Size, PPS) based on the official 2024 population statistics published by the National Statistics Office of Georgia (Geostat). Population data processing and regional sample allocation were performed using IBM SPSS Statistics version 23.0. In the second stage, each region was further stratified into urban and rural areas. A sampling frame was developed for each stratum, based on which municipalities and settlements were selected. The number of respondents was allocated according to a predefined fieldwork plan, ensuring the representativeness of all regions of Georgia as well as both urban and rural populations. Data were collected using a structured electronic questionnaire. Statistical analyses were performed using IBM SPSS Statistics version 23.0. Descriptive statistics included absolute and relative frequencies, means, and standard deviations. Associations between categorical variables were assessed using Pearson's chi-square test, while multivariable logistic regression analysis was used to identify independent factors associated with the study outcomes. Statistical significance was defined as a p-value<0.05. RESULTS: The study demonstrated that population knowledge, perceptions of government regulations, the effectiveness of risk communication, attitudes toward COVID-19 vaccination, and the use of digital health services varied significantly according to age, educational level, and region of residence. Statistically significant associations were identified between previous COVID-19 infection and post-COVID condition, as well as between public trust and sources of health information. The findings also highlighted both the strengths and the challenges of the public health system, particularly in relation to pandemic preparedness, risk communication, and health system resilience. CONCLUSION: The findings indicate that the effective management of the COVID-19 pandemic in Georgia was strongly influenced by population awareness, evidence-based governance, effective risk communication, and the organizational capacity of the health system. The evidence generated by this study provides important implications for strengthening public health policy and enhancing national preparedness for future pandemics and other public health emergencies.